CalAIM Changes: How ARCM Helps with Room & Board

Navigating the CalAIM Changes: How ARCM Can Help California Agencies with Managed Care Room and Board Challenges

California’s CalAIM initiative is a far-reaching, multiyear program designed to transform the state’s Medi-Cal system and improve health outcomes for millions of residents, especially those with the most complex needs. 

One of the most significant changes under CalAIM is the integration of long-term care (LTC) services. This includes room and board for hospice patients and into Medi-Cal managed care plans (MCPs). Since California is the largest hospice market in the U.S., this change has created challenges for many California agencies as they adapt to these regulatory shifts.

If your agency is struggling to manage these transitions, Advanced Revenue Cycle Management (ARCM) is here to help. We have been supporting California Hospice Providers from the time these changes took place. Let’s break down the key changes and how ARCM can support your agency during this time of transformation.

The CalAIM Change: A Shift in How Managed Care Handles Room and Board

Under the CalAIM initiative, long-term care services, including hospice room and board, have been fully integrated into Medi-Cal managed care plans. Previously, payers typically covered these services separately. With CalAIM, managed care plans now cover and coordinate all aspects of institutional LTC. 

Using a phased approach, this transition started in 2023 with skilled nursing facility (SNF) stays. In 2024, the change expanded to include Intermediate Care Facilities for Developmentally Disabled (ICF-DD) services.

This integration means that Medi-Cal managed care plans (MCPs) are now fully responsible for covering all LTC benefits within their network. For agencies that manage these services, this is a significant shift that requires careful attention to detail. It also requires compliance with new regulations and an understanding of how to navigate these changes.

The Challenges for California Agencies

While the CalAIM initiative was designed to provide more consistent coverage and better-integrated care, the changes have left many agencies struggling to keep up with the new requirements. Particularly in the hospice sector, where services often overlap and clients may have complex care needs, agencies are finding it challenging to stay compliant with new room and board regulations under MCPs.

The challenges and changes haven’t just taken place on the agency level. They’ve also with the MCPs who’ve had to adopt equally on the payer end. This has led to payment delays and variances from MCP to MCP which has been further burdensome and confusing to hospice providers. 

The complexities of these regulatory changes are causing some agencies to seek additional help. This is particularly true in managing reimbursement processes and ensuring that all aspects of care are properly coordinated. This includes understanding the phased implementation process, handling billing for room and board within the new managed care framework and necessary follow-up with MCPs to unlock claims that should be processed.

How ARCM Can Help

ARCM has the expertise to help agencies navigate complex regulatory changes like those under CalAIM. With experience working in multiple states facing similar changes, we understand how to support agencies in adapting to new managed care requirements. Here’s how ARCM can assist:

Expert Guidance on Regulatory Changes

Our team stays current with the latest CalAIM regulations. We can guide your agency through the changes, ensuring compliance with all state mandates. We understand the nuances of room and board integration in managed care plans. Our team uses our strong payer relationships and experience to help your agency stay on track.

Support with Billing and Reimbursement

We help agencies optimize their billing processes to ensure that all aspects of long-term care, including room and board, are billed correctly under the new MCP guidelines. Our team works closely with your staff to ensure that claims are filed properly and that your agency receives the appropriate reimbursement.

Personalized Solutions

Since we only work with a select number of agencies in California, we offer personalized service tailored to the specific needs of your business. Whether you’re facing challenges with particularly difficult clients or need help with compliance, ARCM is dedicated to providing the support you need.

A Proven Track Record

ARCM has helped agencies in other states navigate similar changes. We bring that experience and expertise to California’s unique market. We know the dynamics of the local landscape and understand the challenges that agencies face. With this knowledge, we can offer solutions that work for you.

Where to Find More Information

The California Medicaid website is a great resource for more details on the CalAIM initiative and the integration of LTC services into managed care. It provides comprehensive information on the phased implementation and requirements for both skilled nursing facilities and intermediate care facilities.

Why Choose ARCM?

ARCM leverages extensive revenue cycle experience and regulatory expertise to help your agency navigate the CalAIM transition. Our focus on providing tailored, hands-on support ensures that your agency can continue to thrive in this evolving environment. If you’re facing challenges with the new managed care room and board regulations, we’re here to help.

Learn more about ARCM today and contact us to see how we can support your agency during this important transition and ensure that your operations remain efficient and compliant.